Suture Techniques

Question 1

platelets aggregate

Answer 1

at low velocity of blood

Question 2

bleeding allows

Answer 2

slows velocity

-platelets can drift

Question 3

first responders

Answer 3

pro-inflammatory cytokines

Question 4

fresher the wound

Answer 4

the more successful the closure

Question 5

graft of skin

Answer 5

to heal large SA wounds

Question 6

three principles of wound repair

Answer 6

1 minimize trauma to tissue

• sharp teeth instead of crushing instruments
• skin hooks, forceps with teeth, sharp needles

3 accurately approximate wound edges and landmarks

Question 7

three phases of wound healing

Answer 7

1 inflammatory
2 proliferative
3 remodeling

Question 8

inflammatory phase

Answer 8

immediately and lasts 5 days

Question 9

proliferative phase

Answer 9

starts within 24 hours seals wound from water

-for 6 months

Question 10

remodeling phase

Answer 10

continues up to two years

-ex/ move the couch from here to here, my wife

Question 11

when can shower with wound?

Answer 11

24 hours proliferative phase is sealed from from water

Question 12

when to close?

Answer 12

fresh wounds

large clean woulds

over cartilage or bone

to reduce scarring

to reduce bleeding

surgically debrided and irrigated wounds

Question 13

when not to close?

Answer 13

old wonds that are contaminated
-unless cosmetic**

abscess that are drained

wounds that have opened after previous repair - secondary intention

possible foreign body in wound

Question 14

laceration closes

Answer 14

from the bottom up

pushes fluid and debris out

Question 15

puncture wound closes

Answer 15

early closure of skin stops drainage and leads to abscess formation

Question 16

anesthetics in abscess

Answer 16

dont work well due to generally acidic environment

Question 17

lidocaine

Answer 17

blocks sodium channels of depolarization

Question 18

what leads to scarring

Answer 18

tissue tension

Question 19

deep fixation

Answer 19

needed to control scarring

deeper tissue layers

Question 20

ABCD of wound closure

Answer 20

A-B - superficial

C-D - deep

Question 21

sutures in muscles

Answer 21

always pull out

Question 22

more sutures

Answer 22

greater chance of infection

Question 23

langer lines

Answer 23

close wounds parallel to langer lines for best cosmetic results

provides least tension

Question 24

mobility to sides of wound?

Answer 24

undercut or undermine

• go out 2/3 width of wound
• into subQ tissue

in cases where skin does not come together

Question 25

simple interrupted suture

Answer 25

most common down across up and tie square

Question 26

evert

Answer 26

pucker of wound just want a little eversion

Question 27

for long wounds to close fast

Answer 27

continuous running suture

Question 28

continuous running suture

Answer 28

tension difficult keep equally spaced

Question 29

running lock suture

Answer 29

to keep tension from changing too much in running suture like an interrupted but you loop under last instead of tying off

Question 30

vertical mattress suture

Answer 30

double closure of wound -shallow and deep stitch -place vertical mattress suture at place of greatest tension

Question 31

pulley stitchv

Answer 31

like a lock with a vertical mattress large gaping thigh and abdominal wounds in fluffy folks (fluffy people)

Question 32

horizontal mattress suture

Answer 32

good closure on fragile tissue in between fingers down on groin

Question 33

running subcuticular tissue

Answer 33

totally buried within skin | -this is hot new stuff

Question 34

to avoid puckering with running subQ?

Answer 34

enter skin on opposite side slightly behind where needle exited

Question 35

smallest scar formation

Answer 35

running subticular closure

Question 36

flap problems

Answer 36

apex turning toward heart - area without blood supply - only blood - retrograde

Question 37

flap stitches?

Answer 37

**not interrupted suture put a horizontal suture to allow blood flow

Question 38

make sure an incision

Answer 38

is 3-4x as long as it is wide

Question 39

6mm mole?

Answer 39

at least 18-24mm long incision

Question 40

less length to width

Answer 40

you'll get a dog ear on the end lift it up - and cut the corner off will take the length out to what it shouldve been

Question 41

clamp needle

Answer 41

between body and swage -curve designed to capture correct bite of tissue with turn of wrist

Question 42

hold forceps

Answer 42

like a pencil | -not serving tongs**

Question 43

forceps without teeth

Answer 43

crush tissue

Question 44

double wrap

Answer 44

only first

Question 45

finer and sharper the needle

Answer 45

less traumatic

Question 46

reverse cutting

Answer 46

for finger nail

Question 47

spatula curved

Answer 47

for big wounds -like abdomen for retention sutures

Question 48

larger the number?

Answer 48

the smaller the size

Question 49

non-absorbable

Answer 49

nylon ethilon ermalon prolene merseline

Question 50

absorbable

Answer 50

gut and chromic gut - days vycryl, monocryl, polyglycolic acid sutures - weeks silk, cotton - years

Question 51

gut suture

Answer 51

days

Question 52

man-made absorbable

Answer 52

with cryl | -weeks to dissolve

Question 53

silk cotton

Answer 53

years to absorb

Question 54

monofilament

Answer 54

needs 6 good knots to stay good for leaving a long time more aseptic

Question 55

braided suture

Answer 55

needs 3-4 knots to stay | -does have pockets for bacteria - increased infection rate

Question 56

butterflys

Answer 56

steristrips

Question 57

dermabond

Answer 57

will bond everything -super glue don't glue your fingers to wound

Question 58

skin staples

Answer 58

for very long wounds placed 4-5mm apart skin edges approxmiated with toothed forceps

Question 59

face stitches

Answer 59

3-5 days

Question 60

scalp stitches

Answer 60

7 days

Question 61

chest and extremity stitches

Answer 61

8-10 days

Question 62

back stitches

Answer 62

10-14 days

Question 63

high tension areas | -joints or hands

Answer 63

10 - 14 days